Is Fosamax (alendronate) worth taking for osteoporosis?

Fosamax (Alendronate) for Osteoporosis: Effectiveness and Recommendations

Fosamax (alendronate) is worth taking for osteoporosis as it significantly reduces fracture risk and is recommended as first-line therapy for both men and women with osteoporosis. 1

Effectiveness of Alendronate

• Alendronate effectively reduces the risk of vertebral, hip, and other fractures in patients with osteoporosis 1
• High-quality evidence shows that alendronate prevents further bone loss and reduces the risk of initial or subsequent fractures in postmenopausal women with osteoporosis (T-scores ≤ –2.5 or those with fragility fractures) 1
• The medication produces sustained increases in bone mineral density (BMD) in postmenopausal women with or without osteoporosis, in men with primary osteoporosis, and in patients receiving systemic corticosteroid therapy 2
• Alendronate reduced the risk of radiographic vertebral fracture, clinical vertebral fracture, and hip fracture by 47-56% in postmenopausal women 2

Dosing Options

• Alendronate is available in multiple convenient dosing options:
  • 10 mg daily or 70 mg once weekly for treatment of osteoporosis 3, 4
  • 5 mg daily or 35 mg once weekly for prevention of osteoporosis 3
  • Also available as Fosamax Plus D (alendronate with vitamin D) 1
• Once-weekly dosing (70 mg) is therapeutically equivalent to daily dosing and offers improved convenience 4

Treatment Duration and Monitoring

• The American College of Physicians (ACP) recommends treating osteoporosis with pharmacologic therapy for 5 years 1
• Bone density monitoring during the 5-year treatment period is not recommended, as patients benefit from reduced fractures even without increases in BMD 1
• After the initial 5 years, continuing treatment may be beneficial for some patients after reassessing risks and benefits 1
• Patients at low risk for fracture should be considered for drug discontinuation after 3-5 years of use 3

Patient Selection

• Alendronate is indicated for:
  • Treatment of osteoporosis in postmenopausal women 3
  • Prevention of osteoporosis in postmenopausal women 3
  • Treatment to increase bone mass in men with osteoporosis 3
  • Treatment of glucocorticoid-induced osteoporosis 3
• Treatment is recommended in women with a T-score of -2.5 or less 1
• For women with T-scores between -1.0 and -2.5, FRAX can assist in making treatment decisions 1
• Pharmacologic treatment should be considered in women with a 10-year risk of major osteoporotic fracture of at least 20% or hip fracture risk of at least 3% 1

Safety Considerations

• Alendronate is generally well-tolerated when taken as recommended 2
• Most common adverse events are transient and affect the upper GI tract (abdominal pain, nausea, dyspepsia, acid regurgitation) 2
• Important safety precautions:
  • Must be taken with a full glass of water after an overnight fast 5
  • Patient must remain upright for at least 30 minutes after taking the medication 1
  • Contraindicated in patients with abnormalities of the esophagus, inability to stand/sit upright for 30 minutes, or hypocalcemia 1
• Rare but serious adverse effects include atypical subtrochanteric fractures and osteonecrosis of the jaw 1

Special Populations

• In men with osteoporosis, alendronate is effective for increasing bone mass 3
• For glucocorticoid-induced osteoporosis, alendronate is effective regardless of dose or duration of glucocorticoid use 3
• Alendronate is similarly effective regardless of age, race, gender, underlying disease, baseline BMD, and use with common medications 3

Clinical Outcomes

• In clinical studies, patients reported significant reduction in pain and need for analgesics after alendronate treatment 6
• Improved daily activity and mobility of the spine were observed in patients with postmenopausal osteoporosis 6
• No impairment of bone quality has been observed with alendronate treatment 2

Practical Recommendations

• First-line therapy for osteoporosis usually consists of bisphosphonates like alendronate 1
• Specific administration instructions must be followed to reduce the risk of upper GI adverse events 2
• Adequate calcium and vitamin D intake should accompany alendronate treatment 7
• Fosamax Plus D provides both alendronate and vitamin D in a single weekly dose 7